Healthcare Provider Details

I. General information

NPI: 1386825784
Provider Name (Legal Business Name): LING HUANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 E IMPERIAL HWY
PLACENTIA CA
92870-1718
US

IV. Provider business mailing address

1237 E IMPERIAL HWY
PLACENTIA CA
92870-1718
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-8717
  • Fax: 714-983-7859
Mailing address:
  • Phone: 714-247-8717
  • Fax: 714-983-7859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12995-T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: